PURPOSE: To examine changes in clinical practice patterns following the introduction of diagnosis-related groups (DRGs) under the fee-for-service payment system in July 2013 among Korean tertiary hospitals and to evaluate its effect on the quality of hospital care. MATERIALS AND METHODS: Using the 2012–2014 administrative database from National Health Insurance Service claim data, we reviewed medical information for 160400 patients who underwent cesarean sections (C-secs), hysterectomies, or adnexectomies at 43 tertiary hospitals. We compared changes in several variables, including length of stay, spillover, readmission rate, and the number of simultaneous and emergency operations, from before to after introduction of the DRGs. RESULTS: DRGs significantly reduced the length of stay of patients undergoing C-secs, hysterectomies, and adnexectomies (8.0±6.9 vs. 6.0±2.3 days, 7.4±3.5 vs. 6.4±2.7 days, 6.3±3.6 vs. 6.2±4.0 days, respectively, all p < 0.001). Readmission rates decreased after introduction of DRGs (2.13% vs. 1.19% for C-secs, 4.51% vs. 3.05% for hysterectomies, 4.77% vs. 2.65% for adnexectomies, all p < 0.001). Spillover rates did not change. Simultaneous surgeries, such as colpopexy and transobturator-tape procedures, during hysterectomies decreased, while colporrhaphy during hysterectomies and adnexectomies or myomectomies during C-secs did not change. The number of emergency operations for hysterectomies and adnexectomies decreased. CONCLUSION: Implementation of DRGs in the field of obstetrics and gynecology among Korean tertiary hospitals led to reductions in the length of stay without increasing outpatient visits and readmission rates. The number of simultaneous surgeries requiring expensive operative instruments and emergency operations decreased after introduction of the DRGs.
Cesarean Section ; Diagnosis-Related Groups* ; Emergencies ; Female ; Gynecology* ; Health Care Costs ; Humans ; Hysterectomy ; Length of Stay ; National Health Programs ; Obstetrics* ; Outpatients ; Practice Patterns, Physicians' ; Pregnancy ; Prospective Payment System ; Tertiary Care Centers*

BACKGROUND: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. METHODS: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. RESULTS: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. CONCLUSION: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.
Classification ; Drug Therapy* ; Fee-for-Service Plans ; Fees and Charges ; Health Care Costs ; Hospitals, General ; Humans ; Information Systems ; Insurance ; Insurance Claim Review ; Insurance, Health ; Outpatients* ; Product Packaging ; Prospective Payment System ; Referral and Consultation

PURPOSE: The implementation of the Korean diagnosis-related groups (DRG) payment system has been recently introduced in selected several diseases including appendectomy in Korea. Here, we report the early outcomes with regard to clinical aspects and medical costs of the Korean DRG system for appendectomies in Seoul Metropolitan Government - Seoul National University Boramae Medical Center throughout comparing before and after introduction of DRG system. METHODS: The DRG system was applied since January 2013 at our institute. After the DRG system, we strategically designed and applied our algorithm for the treatment of probable appendicitis. We reviewed the patients who were treated with a procedure of appendectomy for probable appendicitis between July 2012 and June 2013, divided two groups based on before and after the application of DRG system, and compared clinical outcomes and medical costs. RESULTS: Total 416 patients were included (204 patients vs. 212 patients in the group before vs. after DRG). Shorter hospital stays (2.98 +/- 1.77 days vs. 3.82 +/- 1.84 days, P < 0.001) were found in the group after DRG. Otherwise, there were no significant differences in the perioperative outcomes and medical costs including costs for first hospitalization and operation, costs for follow-up after discharge, frequency of visits of out-patient's clinic or Emergency Department or rehospitalization. CONCLUSION: In the Korean DRG system for appendectomy, there were no significant differences in perioperative outcomes and medical costs, except shorter hospital stay. Further studies should be continued to evaluate the current Korean DRG system for appendectomy and further modifications and supplementations are needed in the future.
Appendectomy* ; Appendicitis ; Diagnosis-Related Groups* ; Emergency Service, Hospital ; Follow-Up Studies ; Health Care Costs ; Hospitalization ; Humans ; Korea ; Length of Stay ; Local Government ; Prospective Payment System ; Seoul

OBJECTIVES: The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.
Adult ; Age Factors ; Ambulatory Care Facilities/economics/*statistics & numerical data ; Cesarean Section/statistics & numerical data ; Costs and Cost Analysis/statistics & numerical data ; Demography ; Diagnosis-Related Groups/economics/*statistics & numerical data ; Fee-for-Service Plans/statistics & numerical data ; Female ; Gynecology ; Humans ; Length of Stay/statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Obstetrics ; Pregnancy ; *Prospective Payment System ; Republic of Korea ; State Medicine/economics/*statistics & numerical data

DPC is the diagnosis dominant classification defined by diagnosis and procedures. The comprehensive daily payment system by DPC is being implemented in 731 hospitals across Japan. Of the hospitals affiliated with the Japanese Federation of Agricultural Cooperatives for Health and Welfare, 24 hospitals introduced this system in 2008. In September 2008 we mailed a questionnaire to them, and 23 hospitals responded. The mean of the comprehensive pay amounted to 105% of the piece rate. The average length of hospital stay shortened from 15.7 to 14.2 days. The bed occupancy rate decreased from 86.5 to 81.4%. For the preservation of the bed usage, most of the respondents said it was essential to keep in contact with neighboring hospitals and clinics. The adaptation rate of clinical pathways was only 29%. The proportion of generic drugs was 5.9%. In the DPC payment system it is necessary to maintain both the quality of medicine and the cost-effectiveness.
Medicine ; payment ; System ; Diagnostic ; With quality

The comprehensive daily payment system by DPC developed the standardization of medical care and cost-effectiveness. We can exchange intelligence of other hospitals through the benchmark. Clinical pathways were useful for both the standardization and cost-benefit analysis. The production of pathways improved the communication between hospital employees. The excessive shortening of the average length of hospital stay decreased the rate of bed usage. The DPC payment system leaves much room for improvement in the quality of medical treatment and care.
payment ; System ; Combined ; Procedures ; Hospitals

PURPOSE: The objective of our study was to figure out costs of nursing services in ICU based on the PCS in order to determine an appropriate nursing fee schedule. METHOD: Data was collected from 2 hospitals from April 15-16 to April 22-23, 2003. The costs of nursing services in the ICU were analyzed by nursing time based on the nursing intensity. The inpatients in the ICU were classified by a PCS tool developed by the Korean Clinical Nurses Association(2000). RESULTS: The distribution of patients by PCS in the ICU ranged from class IV to Class VI. The higher PCS in ICU consumed more nursing time. As a result, the higher nursing intensity, the more the daily average nursing costs in the ICU. CONCLUSION: Our study provides evidence to refine the current nursing fee schedule that does not differentiate from the volume of nursing services based on nursing time. We strongly recommend that the current reimbursement system for nursing services should be applied not only to the general nursing units but also to the ICU or other special nursing units.
Costs and Cost Analysis ; *Fee Schedules ; Humans ; Inpatients/*classification ; Intensive Care Units/*economics ; Nursing Service, Hospital/*economics ; Prospective Payment System ; Time Factors

The purpose of this study was to evaluate the effect of dual bonding technique by comparing microshear bond strength between two different luting methods of resin cement to tooth dentin. Three dentin bonding systems(All-Bond 2, One-Step, Clearfil SE Bond), two temporary cements (Propac, Freegenol) were used in this study. In groups used conventional luting procedure, dentin surfaces were left untreated. In groups used dual bonding technique, three dentin bonding systems were applied to each dentin surface. All specimens were covered with each temporary cement. The temporary cements were removed and each group was treated using one of three different dentin bonding system. A resin cement was applied to the glass cylinder surface and the cylinder was bonded to the dentin surface. Then, micro-shear bond strength test was performed. For the evaluation of the morphology at the resin/dentin interface, SEM examination was also performed. 1. Conventional luting procedure showed higher micro-shear bond strengths than dual boning technique. However, there were no significant differences. 2. Freegenol showed higher micro-shear bond strengths than Propac, but there were no significant differences. 3. In groups used dual bonding technique, SE Bond showed significantly higher micro-shear bond strengths in One-Step and All-Bond 2 (p < 0.05), but there was no significant difference between One-Step and All-Bond 2. 4. In SEM observation, with the use of All-Bond 2 and One-Step, very long and numerous resin tags were observed. This study suggests that there were no findings that the dual bonding technique would be better than the conventional luting procedure.
Dentin* ; Glass ; Prospective Payment Assessment Commission ; Resin Cements* ; Tooth

PURPOSE: The purpose of this study was to classify the elderly in long-term care facilities using the Resource Utilization Group(RUG-III) and to examine the feasibility of a payment method based on the RUG-III classification system in Korea. METHOD: This study measured resident characteristics using a Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. Data was collected from 530 elderly residents over sixty, residing in long-term care facilities. Resource use for individual patients was measured by a wage-weighted sum of staff time and the total time spent with the patient by nurses, aides, and physiotherapists. RESULT: The subjects were classified into 4 groups out of 7 major groups. The group of Clinically Complex was the largest (46.3%), and then Reduced Physical Function(27.2%), Behavior Problems (17.0%), and Impaired Cognition (9.4%) followed. Homogeneity of the RUG-III groups was examined by total coefficient of variation of resource use. The results showed homogeneity of resource use within RUG-III groups. Also, the difference in resource use among RUG major groups was statistically significant (p<0.001), and it also showed a hierarchy pattern as resource use increases in the same RUG group with an increase of severity levels(ADL). CONCLUSION: The results of this study showed that the RUG-III classification system differentiates resources provided to elderly in long-term care facilities in Korea.
Aged ; Female ; Health Resources/*utilization ; Homes for the Aged/*economics ; Humans ; Korea ; Long-Term Care/*economics ; Male ; Nursing Homes/*economics ; Patients/*classification ; *Prospective Payment System

No abstract available.
Prospective Payment System* ; Prospective Studies*